Tuesday, June 3, 2008

Time to Ban Drug Gifts and Rebates to Doctors?

The Boston Globe yesterday published my op-ed piece here about the extent to which drug companies run misleading ads and use rebates to essentially bribe doctors to prescribe their drugs. I received some interesting feedback, including an email from a lawyer who noted that the legal profession operates under ethical standards that forbid blatant conflicts of interest. He wondered why the ethical guidelines for doctors are more lax, which prompted me to investigate. And he's right: guidelines promulgated by the American Medical Association do not prohibit doctors and dialysis centers from taking substantial rebates on drug supplies they purchase from companies, or from accepting gifts, including meals and free lunches, from drug makers as long as the "gifts are related to the physician's work and are of minimal value (the AMA defines minimal value as gifts of $100 of less, which doesn't seem so minimal to me).

In addition, while doctors in this country are not permitted to own pharmacies, they are allowed to accept rebates and to own or have a financial interest in imaging labs or centers to which they can then refer patients. In an interview today, Dr. Daniel Carlat, a psychiatrist and author of The Carlat Psychiatry Blog, said he considers that "a conflict of interest since it gives doctors a financial incentive to over refer patients to these labs." The same principle is at work when doctors accept generous rebates based on the amount of drugs they prescribe.

As I note in my new book Side Effects: A Prosecutor, a Whistleblower and a Bestselling Antidepressant on Trial, research has shown that such largesse from drug makers can and does influence doctors' prescribing patterns. For that reason, the Massachusetts State Senate recently passed a bill banning any gifts from the pharmaceutical industry to doctors in the state. The bill is currently being considered by the state House of Representatives. If it becomes law, Massachsuetts would join Minnesota and Vermont in either banning gifts worth more than $50 or requiring public disclosure of such gifts, according to The Carlat Psychiatry Blog here .

Seems to me the AMA could do a lot more to discourage doctors from accepting gifts and rebates from the pharmaceutical industry. And so could our state and federal legislators.

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